No one really wants to discuss end-of-life decisions, or what to do when faced with a major medical emergency, but the truth is, it’s an important thing to do. It’s also something you shouldn’t put off.
Unfortunately, a medical crisis can occur at any age that can leave someone unable to make their own healthcare decisions. Determining what you would want to have happen in certain circumstances and expressing your wishes now gives you more control over what happens later, especially if you can no longer speak for yourself or decisions have to be made without your active participation for any number of other reasons.
Taking the Appropriate Steps
The term used for this is Advance Care Planning. It involves:
- Learning about the different types of life-sustaining treatments and efforts that are available (such as giving you CPR or putting you on a ventilator) and deciding which ones you’re comfortable with.
- Thinking about the kinds of life-limiting illnesses or emergencies that you may face and deciding which actions you would or would not want taken in such circumstances (for example, if you would want a feeding tube put in place if you were unable to feed yourself after suffering a stroke).
- Determining where and how you would like to be cared for if that is an option in a given situation (for example, your preference for receiving treatment at home or in a nursing home).
- Discussing your wishes with your loved ones so they know the decisions you would make and, therefore, would want made on your behalf.
- Sharing your personal values and beliefs with your loved ones so they understand the reasons and resolve behind your choices.
- Sharing any relevant information (your wishes, values, and beliefs) with your doctor.
- Completing an advance directive, a document that puts your wishes into writing so it can be used as your “voice” if you are unable to speak for yourself.
Generally, advance directives include a living will and a durable power of attorney for healthcare.
The living will is a document designed to tell doctors, emergency personnel, and other medical workers your wishes for end-of-life care if you can’t speak for yourself. Of course, it can’t possibly cover every type of scenario that may arise, so many individuals will also designate someone who can make healthcare decisions on their behalf, either naming them in their living will or completing a durable power of attorney for healthcare.
A durable power of attorney for healthcare is a legal document that specifies who is in charge of making decisions about your health if you are unable to do so. Sometimes this person is referred to as a healthcare proxy, surrogate, or agent. For some individuals, choosing a healthcare proxy gives them peace of mind for all the “what if” scenarios that can arise, such as a serious car accident. It can also be a welcome option for someone who does not feel comfortable putting major decisions into writing. In this case, they may only have a durable power of attorney for healthcare and not a living will.
Choosing a Healthcare Proxy
Obviously, the person you choose to take on such an important role needs to be someone who understands and respects your wishes and values, and will honor them. This will be especially important in circumstances not addressed in a living will, as the healthcare proxy will need to take into account what they know about you to make an educated guess about what you would want to have happen.
It also helps if the person you choose is someone who is like-minded, meaning that you both share the same views and values. And it is a good idea to choose an alternate proxy in case something happens and your first choice of proxy cannot be used.
Take the time to discuss as many scenarios and medical topics (kidney dialysis, blood transfusions, CPR, feeding tubes, etc.) as possible with your healthcare proxy. As we’re all aware, life can be very unpredictable, so the more you know and can cover your bases, the better.
An important note: Be sure not to confuse a durable power of attorney for healthcare with a durable power of attorney. A durable power of attorney for healthcare is limited to decisions regarding healthcare. A durable power of attorney can make decisions about property and financial matters.
Putting It All Together
To put your advance directives together, you can seek the assistance of a lawyer, but it is not required that you do so. To make the process easier, some states have their own advance directive forms you can use and fill out to your preferences.
Some states will have different requirements for how the advance directive is recognized, whether it is by having the document signed by a witness or notarized. Be sure you follow the right steps to ensure your document would be acceptable and recognized in your state. Also, if you spend time in multiple states - perhaps frequently visiting relatives or spending winters in the south and summers in the north - it’s a good idea to have an advance directive for each state.
Once your advance directive is complete, give a copy of it to your main healthcare proxy, backup proxy, and healthcare provider. Share the location of your document with friends and family in case they need to reference it for any reason and regularly review it to make sure it still fits with your values and health conditions.
Remember, you can change your healthcare proxy or wishes if you want to. If so, don’t delay. Make the changes as quickly as possible and make sure you replace all the old copies of the advance directive with the new one.
This is such an important topic, we want to close with some additional resources from the National Institute on Aging to help you plan: